Healthcare Provider Details

I. General information

NPI: 1801947270
Provider Name (Legal Business Name): GA DIAGNOSTICS SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 COUNTY ROAD 10
SAMSON AL
36477-8054
US

IV. Provider business mailing address

4850 COUNTY ROAD 10
SAMSON AL
36477-8054
US

V. Phone/Fax

Practice location:
  • Phone: 850-537-9389
  • Fax: 850-537-9398
Mailing address:
  • Phone: 850-537-9389
  • Fax: 850-537-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateAL

VIII. Authorized Official

Name: AMANDA PERSAUD
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-537-9389